01 Dec 00 - Medicine - Breastfeeding may guard against HIV

Sarah Boseley, health editor

Guardian ... Friday 1 December 2000

Breastfeeding may be the best way for mothers who are HIV positive to safeguard their babies from the infection, especially in the developing world, according to scientists whose work suggests that the conventional wisdom is badly flawed.

Virtually all women in the west who are HIV positive give their babies bottled formula milk, which experts have maintained is the best way to protect them from becoming infected with the virus.

But this advice, backed by the World Health Organisation, has been hard to follow for women in developing countries, who may not be able to afford formula milk and who risk revealing their HIV status to the entire community if they do not breastfeed. Most worryingly, the shortage of clean water in many areas means that bottles can give babies other serious infections.

Pilot studies by a well-respected South African paediatrician, Jerry Coovadia, and his colleague, Anna Coutsoudis, show that women who exclusively breastfeed their babies run little or no risk of transmitting HIV to them. Their work, in a rural area of KwaZulu Natal, two hours from Durban, where only 5% have clean water and where cholera outbreaks are common, shows that exclusive breastfeeding is as safe as exclusive bottle feeding in terms of HIV transmission, and that considered in the context of the general health of the babies, it is better for them.

A three-year project involving 2,000 women is likely to be launched next year, funded by the Wellcome Trust, to settle a fraught issue that is vital for the future of HIV/Aids management in the developing world.

"If more extensive research proves that exclusive breastfeeding is no more risky than formula feeding, this has profound implications for preventing the spread of HIV in Africa and the developing world," said Prof Coovadia.

"As well as the many advantages of exclusive breastfeeding - its cultural appropriateness, simplicity and well-documented health benefits - another major plus is that breast milk is free."

His work has shown that the least safe method of feeding is the one most often practised in Africa - mixed breast and formula feeding. The scientists believe that contaminated water in the bottles may damage the baby's gut, allowing any HIV virus in the milk, which might pass through harmlessly, to enter the infant's system.

The scientists published an early report of their findings in the Lancet last year. Their as yet unpublished follow-up of the children at 15 months old shows that the exclusively breastfed babies continue to thrive and are HIV free.

"It is a unique observation by Coovadia and Coutsoudis that if you exclusively breastfeed, with no additional feeds including water, you have minimal or no risk of transmitting HIV," said Michael Bennish, director of the Wellcome Trust's Africa centre, where the study is based. "Not everyone accepts that."

If breastfeeding is found to be the safest option for the developing world, one of the last objections to the use of drugs like nevirapine to prevent mothers transmitting the HIV virus to their babies during childbirth will have been removed. It has been argued that there is no point giving women and their infants the tablets, which are cheap and in some places have been donated free, because the babies will inevitably be infected through their mothers' milk unless an expensive programme to provide formula and clean water can be put in place as well.

01 Dec 00 - Medicine - Genes used to overcome heart defects

By Roger Highfield, Science Editor

Telegraph ... Friday 1 December 2000

Gene transplant experiments have successfully quelled abnormal heart rhythm in pigs, paving the way for a way to beat heart disease in humans .

Dr Eduardo Marban, a member of the team at Johns Hopkins University in Baltimore, Maryland, said in the journal Nature Medicine that the genes were delivered by a catheter, with "no open chest, no contrivances."

The researchers used a virus to introduce copies of a gene directly into one of the heart's pacemakers, a small area of tissue called the atrioventricular node. The node receives and filters impulses from the upper chambers and relays impulses to the lower chambers, where they trigger contractions.

In diseased hearts, however, upper chamber heart rhythms may create abnormally fast, irregular heart rates. The team implanted an "inhibitory G protein" gene which makes a protein which blocks an adrenalin-triggered set of reactions that speed the heart rate.

They then stimulated the hearts to produce atrial fibrillation, a serious arrhythmia, when both upper heart chambers quiver chaotically, at up to 600 times a minute. The test animals implanted with the inhibitory G protein showed a 20 per cent decrease in heart rate compared with untreated animals.

Blood cells can turn into brain cells , according to studies that are likely to be used by the pro-life lobby to campaign against attempts to broaden the uses of human embryos in research.

The studies are the first to demonstrate that bone marrow cells migrate in the body and change into nerve cells. They also carry the extraordinary implication that a normal brain is maintained by cells from the bones .

MPs will soon vote on amendments that would allow the Human Fertilisation and Embryology Authority to license research projects involving special cells from early embryos, either spare IVF embryos or clones. Called stem cells, they hope to use them to create cells and transplant tissue to treat leukaemia, heart disease, burns and neurodegenerative diseases such as Parkinson's.

New work, published today in the journal Science, suggests that adult stem cells, taken from bone marrow, could be used to repair brain injuries and treat neurodegenerative diseases, offering an alternative to embryonic cells. The Royal Society and Dr Eva Mezey, one of the scientists involved in the new work, said yesterday that it was too early to say which approach would prove fruitful.

In the first study, Dr Mezey and colleagues at the US National Institute of Neurological Disorders and Stroke, Bethesda, injected newborn female mice with bone marrow cells from normal male mice so that they were easy to distinguish by genetic tests. Four months after the transplants they found a significant number of descendants of these cells had turned into nerve cells in brain regions.

She believes that in a normal brain there is a low level of repair that relies on this mechanism. But, she said: "this system is made for maintenance and not for repairing a major insult." In the second study, Dr Helen Blau and colleagues at Stanford University injected labelled bone marrow from adult mice into other mice.

They found that bone marrow-derived cells migrated into several regions of the brain and that some of the marrow-derived nerve cells also grew long fibres and produced a protein that indicated cell activity. The studies suggest that bone marrow, an easily available source of cells from long bones, could be used as a source of brain cells to replace those damaged.

01 Dec 00 - Medicine - Stem cell hope for brain injuries

By Mark Henderson, Science Correspondent

Times ... Friday 1 December 2000

Stem cells taken from bone marrow will develop into nerve cells in living animals , scientists have shown.

The results of two American studies, reported in Science yesterday, are the best indication yet that bone marrow stem cells could be used to treat neurological disorders such as Parkinson's disease and traumatic brain injuries.

The findings will intensify debate about whether research into stem cells from cloned human embryos should be permitted, a subject on which MPs are preparing to vote. Many critics of the proposals say stem cells from less controversial sources, such as a patient's own bone marrow, may offer similar benefits.

Previous research has shown that bone marrow stem cells can develop into neurons in laboratory cultures, but the new studies are the first to do so in live animals. The American scientists found that when injecting stem cells from one set of mice to another, the cells grew into nervous tissue.

In separate research, to be published this month in The Lancet, French researchers say they have used brain cells from aborted foetuses to repair brain damage in patients with Huntington's chorea.

30 Nov 00 - Medicine - Vaccine protects against Ebola

By David Derbyshire, Science Correspondent

Telegraph ... Thursday 30 November 2000

Scientists have developed a DNA vaccine for the deadly Ebola virus in monkeys, paving the way for a preventative drug for people.

The vaccine has been shown to offer complete protection against the disease, one of the most virulent. Ebola kills up to 90 per cent of all people it infects, breaking down blood vessels and causing catastrophic internal bleeding. Although it is a scarcer public health threat in developing countries than other diseases, Ebola is still one of the most feared. An outbreak in September triggered panic in Uganda and led to at least 115 deaths.

The new vaccine, reported today in the journal Nature, was developed by a team at the National Institutes of Health in America. Previously scientists have successfully tested a vaccine on rodents. The latest version is the first to trigger immune system protection in primates. Ebola is transmitted in body fluids with a small drop of blood or sweat enough to pass on the disease. Its virulence has made the development of a vaccine difficult.

The virus strikes quickly, giving the body little time to launch an effective immune response. As it breaks down the walls of arteries, victims experience severe pain and high fever. Three strains named Zaire, Sudan and Ivory Coast, cause the most deaths.

30 Nov 00 - Medicine - Foetal cells 'halt brain disease'

By David Derbyshire, Science Correspondent

Telegraph ... Thursday 30 November 2000

Brain cells transplanted from aborted foetuses can stave off the debilitating symptoms of Huntington's disease, scientists reported last night.

A team of French researchers says transplants have maintained or improved brain function in three patients with the genetic brain disorder.

Although foetal brain tissue has been used to treat Parkinson's disease since the late 1980s, the findings, due to be published in The Lancet tomorrow, show that the technique could be applied to a wider range of conditions.

The team from Inserm, the Institute of Health and Medical Research in Paris, transplanted tissue from the brains of seven to nine-week-old foetuses into the five patients with mild to moderate Huntington's.

They used cells from the striatum, the region of the brain linked to the disease. A year later, three of the patients had improved motor control and cognitive function.

A new era in transplant medicine was heralded by doctors yesterday with the announcement of an important advance in the treatment of a brain disease.

Researchers at Inserm, a French medical institute in Paris, who transplanted stem cells from foetuses into the brains of people with Huntington's Chorea, said the cognitive function and control of their movements had improved. Of five patients treated, three benefited from the treatment.

The findings, due for publication in The Lancet on 9 December, were released after they were leaked to the French newspaper La Parisienne. A spokesman for The Lancet said: "The French are extremely excited about this."

Stem cell transplants are generating intense interest as a potential treatment for a range of diseases. Stem cells are the body's master cells, capable of developing into any of the body's 200 specialised tissues.

The announcement of the French team's findings, although preliminary, will boost supporters of the cloning of embryos to provide stem cells for therapeutic purposes. A report by the British Government's chief medical officer, Professor Liam Donaldson, recommending that therapeutic cloning be allowed, is to be debated by Parliament in the next few weeks.

The technique would be of particular relevance to sufferers of Huntington's chorea, who have a 50-50 chance of passing on the affliction to their children. Affected children develop dementia and the associated symptoms from adulthood onwards. If the early findings from the French research are confirmed, cells could be extracted and cloned from Huntington's sufferers in childhood to produce stem cells, which could be frozen and transplanted back into them when they developed the disease as adults.

Similar research to that in France is being conducted at the brain repair centre in Cambridge - which is linked to Addenbrooke's hospital - where four operations have been done. A stem cell transplant was also conducted by an American team on a stroke patient last year, with limited success.

Huntington's chorea is an inherited neurodegenerative disease, which affects 7,000 people in the UK causing involuntary movements and dementia. Over 10 to 20 years, affected patients suffer an inexorable downward course to a state of complete physical and mental helplessness. There is no cure and stem cell transplant offer the first hope of one.

30 Nov 00 - Medicine - Scientists develop a vaccine for Ebola virus

By Steve Connor, Science Editor

Independent ... Thursday 30 November 2000

Scientists have developed a potential vaccine against the highly contagious Ebola virus, which has until now proved difficult to combat because of the speed at which it strikes.

Research published today shows that the vaccine successfully protected laboratory monkeys against Ebola infection, raising the prospect of clinical trials on human volunteers within two years.

Ebola and Marburg virus, its lesser known cousin, cause haemorrhagic fever, which begins with flu-like symptoms but quickly develops into bleeding gums, eyes and nose, followed by internal haemorrhaging and death in up to 90 per cent of victims.

The vaccine works on two levels: it stimulates production of the virus-killing cells of the immune system, and it encourages the production of antibodies that can identify and destroy invading viruses.

Gary Nabel, who led the research team at the National Institutes of Health near Washington in the United States, said a vaccine was the only way to fight the ruthless efficiency of Ebola, which usually kills within 10 days. "Doctors have essentially been helpless against Ebola. We have not known if immunity to the virus exists or what parts of the immune system are important," he said.

"Our studies show that animals can launch an effective immune response against Ebola virus, and we can use knowledge of this response to design a vaccine that protects non-human primates from infection. Although much more work needs to be done, we hope this moves us closer to new vaccines and treatments for Ebola and other viruses."

Research published in the journal Nature shows that four monkeys injected with the vaccine remained healthy after a potentially lethal injection of Ebola virus. Four unvaccinated monkeys died of the disease.

The vaccine was made from fragments of DNA from Ebola, which caused the production of viral proteins within the monkey, thereby stimulating virus-killing immune cells. A second injection with a weakened strain of a cold virus that was genetically engineered to contain parts of Ebola completed the full antibody immunity.

Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said the findings marked an important turning point in controlling Ebola.

"Ebola is a difficult virus because currently available antiviral drugs have no proven effect on it and we do not know its natural reservoir, making environmental control impossible," Dr Fauci said. "A vaccine is therefore the best hope for protecting humans from infection, and this study makes some key advances."

Ebola first emerged from the rainforests of central Africa in 1976, with outbreaks in Sudan and the Democratic Republic of Congo. Further outbreaks have struck Zaire, Uganda and the Ivory Coast.

The DNA vaccine has been carefully designed to include elements of the three known Ebola strains to ensure it will work against all possible unexpected outbreaks.

Dennis Burton and Paul Parren, immunologists from the Scripps Research Institute in La Jolla, California, said in an accompanying article in Nature that the latest study used only low doses of Ebola against the monkeys. It was important to repeat the work with higher doses. "There's still some way to go before a human vaccine is available, but this is a step in the right direction."

30 Nov 00 - Medicine - Early menopause 'caused by genes'

By Steve Connor, Science Editor

Independent ... Thursday 30 November 2000

Doctors in New Zealand have found a possible genetic basis for premature meno-pause, which affects one in 100 women under the age of 40 and can strike with little warning, even in teenagers.

A study published today has found that premature ovarian failure (POF), a condition in which menstrual periods stop and hormone levels change, is strongly linked to a genetic mutation in one of the three genes involved in controlling the secretion of female hormones.

The mutation occurs in the "alpha" gene for inhibin, aprotein that is involved in regulating follicle stimulating hormone, which helps eggs to mature each month in a woman's ovaries.

A research team from the University of Auckland collected the medical histories and analysed the DNA of 43 women who had suffered POF.

In a study published in the journal Human Reproduction, the researchers reveal that three of the women had mutations in the inhibin gene, a prevalance that was 10 times greater than expected. The findings may mean that genetic tests for detecting such defects could be used to indicate whether a young woman was at risk of premature menopause.

Andrew Shelling, who led the research team, said that if genetic testing showed younger women that "there were indications that they were at risk of premature menopause, they may want to rethink their reproductive plans. But that is highly speculative for now."

According to Dr Ingrid Winship, also from the University of Auckland, women with a family history of premature menopause could be the first to benefit from such a test.

A new era in transplant medicine was heralded by doctors yesterday with the announcement of an important advance in the treatment of a brain disease.

Researchers at Inserm, a French medical institute in Paris, who transplanted stem cells from foetuses into the brains of people with Huntington's Chorea, said the cognitive function and control of their movements had improved. Of five patients treated, three benefited from the treatment.

The findings, due for publication in The Lancet on 9 December, were released after they were leaked to the French newspaper La Parisienne. A spokesman for The Lancet said: "The French are extremely excited about this."

Stem cell transplants are generating intense interest as a potential treatment for a range of diseases. Stem cells are the body's master cells, capable of developing into any of the body's 200 specialised tissues.

The announcement of the French team's findings, although preliminary, will boost supporters of the cloning of embryos to provide stem cells for therapeutic purposes. A report by the British Government's chief medical officer, Professor Liam Donaldson, recommending that therapeutic cloning be allowed, is to be debated by Parliament in the next few weeks.

The technique would be of particular relevance to sufferers of Huntington's chorea, who have a 50-50 chance of passing on the affliction to their children. Affected children develop dementia and the associated symptoms from adulthood onwards. If the early findings from the French research are confirmed, cells could be extracted and cloned from Huntington's sufferers in childhood to produce stem cells, which could be frozen and transplanted back into them when they developed the disease as adults.

Similar research to that in France is being conducted at the brain repair centre in Cambridge - which is linked to Addenbrooke's hospital - where four operations have been done. A stem cell transplant was also conducted by an American team on a stroke patient last year, with limited success.

Huntington's chorea is an inherited neurodegenerative disease, which affects 7,000 people in the UK causing involuntary movements and dementia. Over 10 to 20 years, affected patients suffer an inexorable downward course to a state of complete physical and mental helplessness. There is no cure and stem cell transplant offer the first hope of one.

30 Nov 00 - Medicine - Envoys avoid gene patent issue

James Meek, science correspondent

Guardian ... Thursday 30 November 2000

Europe will continue to allow the patenting of genes from living things until next year at least, after regulators at a key conference ducked the issue.

The diplomatic conference to revise the European patent convention, which ended in Munich yesterday, decided that it could not debate giving patents to "biotechnological inventions" until the EU had made up its mind on the issue.

This effectively means that the Munich-based European patent office will go on granting patents on human, animal and plant genes, according to powers it granted itself in controversial circumstances last year.

Earlier this month a survey carried out for the Guardian by GeneWatch UK found that worldwide more than 500,000 patents had been applied for on genes or gene sequences in living organisms, from humans to spiders.

There were scuffles outside the EPO building yesterday as police tried to seize patent files from Greenpeace activists who had taken them from the EPO library earlier, claiming they were granted illegally.

Greenpeace activists used welding torches and concrete blocks to set up a large wedge-shaped metal monument outside the building, bearing the words "The new European law on patents: living organisms and their genes shall not be patented." A Greenpeace delegation was allowed to address the conference briefly, but activists and journalists were otherwise not given access to it, apart from a press conference at the close. "The states here are fully aware of their responsibilities," said Dr Roland Grossenbacher, the chairman of the EPO's administrative council.

The conference also postponed another controversial decision - on whether to make it easier for firms to patent computer software.

Scientists are on the track of a vaccine against Africa's nightmare killer - Ebola fever. Researchers at the US National Institutes of Health in Maryland report in Nature today that they successfully vaccinated four monkeys against a lethal dose of the virus.

Ebola is a mysterious microbe that lives in Zaire, Sudan and Ivory Coast, although most outbreaks have been in Zaire. The virus kills nine victims in 10. It strikes quickly, and individuals suffer severe pain, high fever and dramatic internal bleeding before they die. There is no cure and, until today, no hope of a vaccine. Nobody knows where it lives in the wild, or how infection gets into human populations. But once it does, it spreads swiftly.

The US researchers started with lengths of Ebola DNA - rather than proteins from the virus - in their tests on animals. DNA vaccines are a new class of treatments and the thinking is that, like viruses, the vaccines enter the cell and use the cell's machinery to replicate - tricking the host's immune system into thinking a real virus infection has occurred.

They tested it on rats and guinea pigs, and then boosted the immune responses by using a different and safer virus to make Ebola-like proteins which would set the immune system roaring into action.

They vaccinated four macaque monkeys, and then exposed them to huge doses of Ebola. Three showed no sign of any infection, and one showed Ebola in the bloodstream but this disappeared after a week. Six months later, all four were free of any symptoms of the disease.

Gary Nabel, of the vaccine research centre at the institute, said: "Doctors have essentially been helpless against Ebola virus. We have not known if immunity to the virus exists or what parts of the immune response are important. Our studies show that animals can launch an effective immune response against Ebola virus.

"Although much more work needs to be done, we hope this moves us closer to new vaccines and treatments for Ebola and other viruses."

A thousand women a year are still not receiving the breast cancer drugs they need despite new national guidelines, according to a survey published yesterday.

CancerBACUP, the information and advice charity, which conducted the research, said that 600 women were also missing out on the recommended treatment for ovarian cancer.

CancerBACUP is one of two groups helping cancer sufferers which The Times is raising money for as part of its Christmas Appeal. Readers are being asked to contribute towards the £35,000 needed for an extra cancer nurse to run CancerBACUP's busy information phoneline for patients and their relatives.

The charity's survey of health authorities showed that just over 20 per cent have not yet guaranteed that patients will receive the taxanes they need for advanced breast cancer. The use of the drugs was recommended by the National Institute for Clinical Excellence (Nice), the body set up to end the lottery of "postcode prescribing". A further 15 per cent of health authorities could not confirm that paclitaxel (Taxol) was available to ovarian cancer patients, again contrary to Nice guidelines issued in the summer.

Judith Brodie, head of CancerBACUP's cancer support service, said: "Nice stated that taxanes should be made available to a number of women with advanced breast and ovarian cancer. Since than the situation in many parts of England and Wales has improved.

"But our survey shows more than 20 per cent cent of health authorities are still unable to confirm that suitable breast cancer patients are being offered the option of treatment with taxanes. We have to ask: is Nice removing postcode prescribing?" She said it was essential that health authorities were seen to act on Nice guidance, especially with the use of a further 14 cancer drugs due to be assessed by the agency next year.

The findings come as CancerBACUP launches a campaign to ensure that cancer patients get the drugs and therapy they need to combat pain. Its Freedom from Pain leaflet contains advice and a selfassessment form to help patients to describe their needs to a GP or consultant.

28 Nov 00 - Medicine - Scientists find 'low IQ link' to Alzheimer's

By Mark Henderson, Science Correspondent

Times ... Tuesday 28 November 2000

Alzheimer's disease may be linked to low intelligence, according to research by scientists in Scotland.

Researchers at Aberdeen and Edinburgh Universities have discovered that children who do poorly in intelligence tests at the age of 11 are more likely than their peers to develop dementia in their seventies.

The study, published yesterday in the American journal Neurology, is the first to make an explicit link between late-onset dementia, the most common form of which is Alzheimer's, and IQ scores recorded in childhood.

Its findings add weight to theories that the condition is largely governed by genetic factors, and suggest that genes which contribute to intelligence may also help to protect the brain from dementia in old age. The research, led by Lawrence Whalley, professor of mental health at the University of Aberdeen, relied on a unique database of intelligence test scores for more than 89,000 Scots who were 11 years old in 1932.

The records, held by the Scottish Council for Research in Education, allowed the team to trace 892 people living in Aberdeen who had taken the test. When they compared test results from the Aberdeen group with subsequent medical history, they discovered that the 50 patients who had been diagnosed with late-onset dementia had recorded much lower average intelligence test scores than those who had not developed the disease.

The level of the average scores, which were not measured in terms of modern IQ ratings, were not published for either group.

"We soon realised there was something unique about childhood intelligence that could be traced to what happened to people when they reached their mid to late seventies," Professor Whalley said. "We wondered if intelligence was linked to the risk of dementia, and it was clear that it is."

The link between low childhood intelligence and Alzheimer's was not significant until patients reached the age of 72, he added. When patients reached the age of 77, the link became still more pronounced. "What we are seeing is the long reach of childhood. Childhood intelligence seems to correlate quite closely with when people become most vulnerable to Alzheimer's," Professor Whalley said.

"The geneticists on the team will tell you that the genes for intelligence may be the same as the genes for dementia. This strengthens what we call the reserve hypothesis: that the brain, like other organs, has a certain processing capacity that is gradually depleted as we age."

There was no link between low intelligence scores and early-onset dementia prior to the age of 65, according to the study.

Harry Cayton, the chief executive of the Alzheimer's Society, said: "This is one of many emerging studies on potential risk factors for Alzheimer's disease. Although the research is interesting, it is clearly not the case that only people with low IQs develop dementia - the late Iris Murdoch is an obvious example of a highly intelligent woman who developed this devastating disease.

"We don't yet fully understand what causes Alzheimer's disease. It is most likely to be a combination of factors, including lifestyle, genetics and environment."

28 Nov 00 - Medicine - Muscle disease advance

By Mark Henderson

Times ... Tuesday 28 November 2000

A gene therapy for the most common form of muscular dystrophy has been developed by American scientists, raising hopes of a breakthrough in the fight against the disease.

The therapy, which uses a version of the gene responsible for Duchenne muscular dystrophy, has been successfully tested on laboratory mice by researchers at the University of Pittsburgh. If the results are repeated in further animal tests, the treatment could be ready for clinical trials within five years, although it is likely to be at least ten years before drugs based on the technique appear on the market. Duchenne muscular dystrophy, the most common form of the muscle-wasting disease, is an inherited disorder affecting one in 3,500 boys. Sufferers lack a working copy of the gene for the protein dystrophin, which is vital to the development of muscles. They usually die before the age of 20.

The Pittsburgh researchers, who report their results today in Proceedings of the National Academy of Sciences, used a "mini-gene" for dystrophin, with fewer than 4,200 DNA elements compared with 16,000 in the normal gene, making it easier to use for therapeutic purposes. When the calf muscles of mice with muscular dystrophy were injected with the therapy, almost 90 per cent of the tissue treated began to produce dystrophin - a much better result than has been previously achieved. The muscle tissue continued to produce the protein throughout the year-long span of the experiment.

Martin Bobrow, chairman of the Muscular Dystrophy Campaign, said the study was a "major step forward".

Hopes that the morning-after pill would be on unrestricted sale in time for the Christmas party season - to help limit the number of unwanted pregnancies in the new year - were dashed yesterday.

Health officials said it was "highly unlikely" that the emergency contraceptive, which is currently available only on prescription, would be switched to over-the-counter sale before 2001, contrary to reports in some newspapers.

The controversial pill is taken in two doses - 12 hours apart - after unprotected sex to prevent pregnancy.

The Medicines Commission, an advisory body to the Medicines Control Agency, recommended in July that the pill could be sold without a prescription to anyone over the age of 16.

A spokeswoman for the Department of Health said the recommendation had been with ministers since September but that they had not yet made a decision. It was felt that MPs should be allowed a chance to debate the issue, but there had been a lack of parliamentary time, she said.

The spokeswoman added: "We don't have any details of when the decision will be made. From a logistical point of view, it is highly unlikely [that the pill will go on sale before Christmas] because the company is going to need time to manufacture the product and produce the patient information."

Family planning campaigners have urged ministers to make the morning-after pill more easily available to help cut Britain's high teenage pregnancy rate and reduce the number of abortions.

A study of 1,000 women in Edinburgh, half of whom were given a single course of thepills to keep for use in an emergency, found that the women had 30 per cent fewer unwanted pregnancies after one year than those who had to obtain the pills by prescription.

The study, by Dr Anna Glasier and Professor David Baird of the University of Edinburgh, was published in The New England Journal of Medicine in 1998. Another study in Manchester found similar results.

Ann Furedi, director of the British Pregnancy Advisory Service, said it was important that women should have ready access to emergency contraception, especially during the Christmas holiday.

"We know there is always an increase in abortions in the post-Christmas holiday period. People often find it very difficult to access doctors and family planning clinics over Christmas," Ms Furedi said.

28 Nov 00 - Medicine - Epidemic feared as measles jab rate drops

By Jeremy Laurance, Health Editor

Independent ... Tuesday 28 November 2000

London is facing a measles epidemic that could strike at any time because of the low level of immunisation among children in the capital.

Public health experts are warning that vaccination rates have dropped so low in some districts that an outbreak of the disease is increasingly likely. They point to the position in Dublin where measles has struck 1,569 people this year, put more than 100 in hospital and caused two deaths.

Dr Mary Ramsay, head of measles monitoring at the Public Health Laboratory Service, a government agency, said: "From the data available at the moment, several parts of London are already at risk of an epidemic. They have levels of immunisation low enough to be capable of sustaining an epidemic if the virus were introduced into the population."

The most vulnerable area is Croydon, with an MMR immunisation rate among children aged two of 74 per cent, the same as that in the Eastern Health Board region of the Irish Republic, which includes Dublin.Eight other districts in London with immunisation rates below 82 per cent are giving the greatest cause for concern.

Dr Ramsay said: "We are very worried about it. Parts of London are getting down to the Dublin level [of immunisation]. They [in Dublin] have been lower for longer but as the years accumulate the risk of an epidemic [in London] grows."

Public health experts say an immunisation rate of 95 per cent is necessary to halt outbreaks of the disease by preventing the build-up of a pool of susceptible individuals through whom the virus can spread. Immunisation rates against MMR have fallen by 5 per cent nationally, and 6 per cent in London, since 1998, after publication of a controversial theory linking MMR with bowel disease and autism. Subsequent studies have failed to confirm the link.

One of the biggest falls in immunisation rates has been seen in south Wales, where a local paper has run a campaign against MMR. Wales's chief medical officer, Ruth Hall, has written to doctors highlighting the seriousness of the situation and an educational pack has been produced for health workers to encourage parents to have their children vaccinated.

However, London - where the overall immunisation rate is 80 per cent, 8 percentage points below the national average - is at greatest risk because of the size of its population and the number of visitors from overseas who may bring the infection with them.

The maximum risk of an outbreak will happen when children who missed their vaccination in 1998, at the height of the scare when they were aged two, start school next year at age five and come into contact with other children.

Dr Ramsay said the deaths of two children in Dublin had highlighted the risks of the disease, which is often dismissed as a mild childhood infection. "The severity of the outbreak in Ireland reflects what we have have always said - that this is a nasty disease. It is a myth that measles isnot serious."

Britain's last measles epidemic was in 1988, just before the MMR vaccine was introduced, when there were 80,000 cases. The past three years have seen outbreaks in unvaccinated groups in Steiner schools and religious communities who oppose vaccination.

In Salford, Greater Manchester, more than 100 cases of measles have been notified from one religious community in the past year. Three patients were admitted to hospital with complications.

In the Netherlands more than 2,300 cases have arisen in the past year among a community that is philosophically opposed to vaccination. Three children died, and 53 spent time in hospital.

The official inquiry into the health risks of mobile phones published last May found no evidence of any detrimental effects on users' health apart from a demonstrably greater risk of car accidents for anybody driving while having a telephone conversation.

However, the working party chaired by Sir William Stewart, a former government chief scientist, argued in favour of the "precautionary principle " and said mobile phone users should be made aware of the limitations of scientific research and make up their own minds about what action, if any, to take.

The panel's advice has now prompted ministers - with the lessons of the BSE crisis still fresh in their minds - to issue warnings to consumers planning to buy mobile phones in the run-up to Christmas.

The 12 independent experts on the committee, including Sir William, did not give cellphones the all-clear because even though no study to date has shown an unequivocal health risk, the absence of clear evidence means there could still be a risk to users. "We all know what happened about BSE," Sir William said on the publication of his report, mindful of the view in the early 1990s that there was no evidence that "Mad Cow" disease threatened human health.

But Sir William's report did recommend that the mobile phone industry should refrain from promoting the use of cellphones to children on the basis that if there was a risk, then children are likely to be in the greatest danger.

"If there are currently unrecognised adverse health effects from the use of mobile phones, children may be more vulnerable. In line with the precautionary approach, widespread use by children for non-essential calls should be discouraged," Sir William said.

Sir William added that he was against giving children "unfettered access" to cellphones: "The younger the child, the more care should be taken in allowing them to use mobile phones," he said.

Children are more likely to be at risk because their brains are still developing, their skulls are thinner and their heads are smaller, which means they receive a proportionately large dose of microwave radiation.

Most of the research carried out on mobile phones has involved exposing cells or tissues to high levels of radiation. So far, the results have been unclear about whether the phones pose a health risk.

Alan Preece, a researcher at Bristol University, has conducted the only research so far to be carried out on human volunteers, who underwent a range of psychological tests while using a mock device that simulated the radiation emissions of a mobile phone.

Mr Preece failed to find any effects on memory, despite reports to the contrary published by some newspapers. He did, however, discover that people's reaction times tended to improve while on the phone.

This concerned him because radiation from mobiles may be having some effect on the brain, possibly by a local heating effect, which may be improving blood supply to one side of the user's head. Another investigation by Which?, the consumer magazine, found that use of hands-free devices - which are often sold on the promise that they can lessen radiation exposure to the head - can actually increase radiation doses by up to three times as the earpiece acts as an aerial that channels microwaves to the brain.

But the research on which these findings were based has been disputed by other scientists, especially those working for the Federation of the Electronics Industry, which criticised the methodology of the Which? researchers.

After the Stewart inquiry, the Government is committed to spending millions of pounds on more research, which may eventually find more satisfactory answers on the health risks.

Until then, perhaps the best advice is not to use them while driving: there is evidence that to do so increases the risk of accidents fourfold, even if a hands-free device is used.

26 Nov 00 - Medicine - Gene test can screen embryos for low IQ

Lois Rogers, Medical Correspondent

Times ... Sunday 26 November 2000

Scientists have developed a £125 test that enables doctors to screen embryos for low intelligence. Their testing kit can identify a range of genetic defects known to lead to learning difficulties.

Developed by a British company, it is the first gene test for low IQ and has already been adapted for use by doctors in America and Spain on families they suspect have an inherited risk of a defect.

Using test-tube baby techniques, the American and Spanish doctors have selected only perfect embryos to be returned to the womb.

Some experts are concerned that such testing echoes Aldous Huxley's Brave New World, in which epsilon babies were bred in hatcheries for menial tasks while alphas lived a life of luxury.

"There is an urgent need for regulation of what constitutes legitimate use of this type of genetic diagnosis," said Richard Nicholson, the editor of the Bulletin of Medical Ethics.

"Low IQ is not life-threatening. This is a significant step towards eugenics."

The £125 kit being marketed by Cytocell, of Banbury, was developed from research at the Institute of Molecular Medicine, Oxford.

Scientists have identified the specific arrangements of genetic material on the telomeres, the ends of DNA strands in each chromosome, which cause children to suffer anything from moderate learning problems to mental handicap.

About 21,000 children are born with a learning difficulty in Britain each year. Scientists say the test could identify up to 2,000 of them.

Research is now turning to the quest for other genetic characteristics which may cause sub-normal intelligence, with the ultimate goal of offering screening to women carrying naturally conceived babies.

Cytocell has already produced customised probes for couples at high risk of having mentally retarded children at the St Barnabas Medical Centre in New Jersey and at a genetics centre in Barcelona.

The American government is ploughing federal funds into developing such tests.

26 Nov 00 - Medicine - Lives in balance as gene debate begins

By Jo Dillon, Political Correspondent

Independent ... Sunday 26 November 2000

Benjamin Angel was eight days old when his parents were told he had cystic fibrosis. Now, aged 21, he is a third- year medical student at Cambridge University playing first team tennis and badminton for his college.

Mr Angel describes himself as "very lucky". He was diagnosed early. The disease could be managed. And his symptoms are treated, as long as he stays committed to spending two hours a day with a physiotherapist for the rest of his life, and to taking antibiotics constantly.

But Mr Angel is not cured. On that front, the only hope for him and thousands like him, is gene therapy.

Tomorrow, the Human Genetics Commission - the main advisory body to the Government on human genetics - will launch the first ever public consultation into the use of the controversial science to set up genetic databases and treat hereditary diseases.

Its findings will be reported to ministers in February. And for people like Mr Angel, they could be life-changing - a crucial step in persuading a reluctant public to accept genetic research and its applications. It is expected to recommend a framework of safeguards designed to prevent abuse of the new technology.

The genetic research could be far-reaching. It could lead to every person in Britain being tested to reveal genetic defects in an investigation that could even pinpoint where illnesses might occur. Ultimately, those illnesses might be cured by the use of gene therapy. A disease like cystic fibrosis could be overcome by the introduction of correct copies of the deficient genes into the body, and gene therapy could also benefit people suffering from strokes, diabetes, Parkinson's disease or a damaged liver.
But the research methods are controversial. And debate is raging about who should have access to a person's genetic information and what protection should be put in place to ensure people are not discriminated against or exploited by employers or insurance firms.

Already there are fears, for instance, that an undesirable genetic readout could mean higher premiums, or no insurance at all, for applicants who have taken the test. Information about genetic make-up could also fall into the wrong hands, leading to the data being used for commercial purposes.

The genetic research on which people such as Mr Angel depend is still in its very early stages. "I would imagine it would take around 10 years for an efficient gene therapy, provided research is kept up," he said. But such is the public disquiet over the developments he fears the research may not carry on, thanks to "misinformed" criticism over such things as stem cell research and its depiction by some as "Frankenstein technology" or as "playing God".

"I am absolutely terrified of that," Mr Angel said. "We do have to be aware that these issues are potentially a huge area of research and we should tread carefully. But while the politicians and the churches are causing problems and research is not going ahead as it should do, lives are being lost. People are dying every week. Even if they say they've only slowed things down by six months, in that time people have died all over the world."

He believes that when it comes to treating cystic fibrosis by genetic means, there should be little controversy. Being able to breathe in correct genes through an inhaler is not for him a matter of ethics. "I would say we are not playing God, we are not altering the genetic make-up of anyone, we are putting a correct gene into the lungs of sufferers."

He knows, however, that the threat to scientific advance is real. "I cannot stress how important it is to see the big picture. Yes, it is obviously important to proceed with caution but from my point of view, in gene therapy for cystic fibrosis, I don't see it as much more of an issue than taking a tablet."

To the press, pulpit and Parliament critics of the science, he warns that their "problems" over the developments could mean the loss of the benefits to humanity. "It will get in the way of saving people's lives."

At the Centre for Life in Newcastle, the next step will be taken towards using technology to warn people that they could be prone to certain diseases, and, ultimately, towards replacing damaged or diseased cells.

The Human Genetics Commission's document, Whose Hands on Your Genes? will pose tough questions about how to balance the protection of genetic data while making sure we benefit from the developments. In the consultation document members of the public will be asked how different and special they think genetic information might be compared to other kinds of data, whether that data should be covered by special protection, if family members should be told details about genetic information when relevant, if insurers or employers should have access to genetic information, and if the police should keep genetic databases.

The Government has yet to come to any conclusions about access to genetic profiles. But Labour faces likely clashes with the Conservatives after taking the first steps to approve the release to insurance companies of genetic test results to identify people with Huntington's disease, a fatal inherited brain condition.

Government sourcessaid: "The reason for allowing genetic tests to be in the public domain was precisely because these people were being discriminated against." But they added that to have genetic information made more generally available to the public could be "dangerous".

The Opposition is even more hostile to the sharing of genetic information. One senior Conservative said: "You haven't even got the right to know if your husband has got a sexually transmitted disease, so why should you be told the genetic information about other members of the family?"

Parliament is expected to debate the entire issue of genetics before the end of the year. Things could get heated with strongly-held views on both sides of the argument.

Opponents of stem cell research - one of the most controversial aspects of the genetic revolution - are already mounting their moral campaigns. The Archbishop of Birmingham, the Most Reverend Vincent Nichols, has written to all priests urging them to start a crusade against the cloning of human embryos. His letter was read out to congregations, asking Catholics to lobby their MPs to oppose the research.

22 Nov 00 - Medicine - Airlines must warn of flight health risks

By Melissa Kite, Political Correspondent

Times ... Wednesday 22 November 2000

Airlines will be told today to issue health warnings with long-haul tickets, telling passengers about the danger of blood clots from cramped conditions .

The first official investigation into in-flight conditions will conclude that passengers who travel in first and business class are just as much at risk of "economy class syndrome" as those in the cheaper seats.

All passengers will be cautioned against "sitting like puddings " and overdoing the free alcohol , and instead advised to exercise their legs as much as possible and to drink plenty of water .

Up to 30,000 people die from deep vein thrombosis every year , with pregnant women, smokers and those with heart disease most in danger. Long-haul air passengers are also at risk because blood flow in the legs may be slowed by immobility, dehydration and cramped conditions , but cabin crews have yet to be trained to recognise and treat early symptoms.

Accident and emergency departments close to Heathrow are said to receive at least two long-haul passengers a week with blood clots , and East Surrey Health Authority, whose hospitals cover the Gatwick area, recorded 142 deaths from deep vein thrombosis in the year to April this year. It is believed that many of the victims had been on long-haul flights .

Now a 400-page report from the House of Lords Science and Technology Committee is expected to make a series of tough recommendations to companies on all aspects of health and hygiene, including calling for the ticket health warning that will be likened to that on cigarette packets.

They will also highlight the dangers from the alcohol freely distributed by airlines to pamper their business and first-class passengers: that dramatically worsens dehydration and puts passengers at greater risk of thrombosis.

Airlines are expected to be asked to tell passengers of the potential risks and to instruct cabin staff to include advice on exercise as part of the pre-flight safety demonstration. Those with high blood pressure should also be advised to take an aspirin to thin the blood and to wear support tights.

The committee will also strongly warn airlines to stop the practice of economising on air-conditioning . Airlines tend to turn down the air-conditioning during delays before take-off and during the night when passengers are asleep, effectively making people breathe stale air. This has led to the rapid spread of germs and influenza is known to spread quickly on aircraft.

Lord Graham of Edmonton, who triggered the inquiry when he reported his own experience of deep vein thrombosis to the Lords a year ago, said: "I suspect there will be a lot that the airlines don't like. They like selling alcohol, they don't want people wandering down the aisles getting in the way of the duty-free trolley. But it's something they have to accept responsibility for."

Lord Graham collapsed with a blood clot after flying business class to New Zealand and was told that the condition had developed because he had lain still throughout the journey.

Although passengers have long suspected the dangers of cramped conditions, the link between deep vein thrombosis and long-haul flights has only recently been proved. Research published in The Lancet last week concluded that the risk in air-pressurised cabins was indeed real .

British Airways is also taking part in similar research after the death of Emma Christoffersen , 28, of Newport, South Wales, minutes after stepping off a 23-hour flight from Australia.

Other previously healthy passengers who have died after long flights include Maureen Golding , 66, who collapsed in June this year during a refuelling stop in Hong Kong, and Jennie Metcalfe , 56, who died at Heathrow in March 1998.

Deep vein thrombosis usually occurs in the legs or pelvis, but if it moves through the bloodstream it can cause a fatal pulmonary embolism, an obstruction of a blood vessel in the lungs. Around half of all DVT victims have early symptoms such as swelling . But others show no sign of a clot until a serious problem develops

Instructions on how to distinguish the deserving from the undeserving sick were issued by the Department of Health yesterday to limit the impact of the anti-flu drug, Relenza, on the NHS.

The National Institute for Clinical Excellence (Nice), the government agency for monitoring new treatments, gave the drug limited approval, ending the total NHS ban it imposed a year ago. At the same time, the Department of Health issued its own guidance setting out precisely when, and to whom, the drug should be prescribed.

The institute recommended that "at risk" adults - those over 65 and younger people with health problems such as heart or respiratory disease - should be prescribed the drug, provided they had had symptoms of flu for fewer than 36 hours. It will be made available only when the national level of flu in the community exceeds 50 cases in a population of 100,000.

Relenza has been shown to reduce the severity of flu and to shorten the duration of an attack, but it is ineffective unless started within 48 hours of the onset of symptoms.

The recommendation is a reversal of last year's interim decision, which in effect banned Relenza - whose chemical name is zanamivir - on the NHS. That decision prompted an outburst from Sir Richard Sykes, the chief executive of GlaxoWellcome, who threatened to move research investment abroad if Britain did not accept new drugs.

Yesterday, Andrew Dillon, the chief executive of Nice, defended the organisation's change of heart. "When we reviewed zanamivir last year the data did not show that this product would significantly support the NHS's management of patients with flu. New evidence... demonstrates benefits in using this product for people at risk of serious complications."

The Department of Health acted to protect family doctors, who feared being swamped by demand, and the NHS's financial managers, who had cost anxieties. Relenza is priced at £24 for a five-day course. In the event of unfettered prescribing, the total NHS bill is estimated at more than £100m.

The department said nurses and pharmacists would be able to prescribe the drug after taking patients through a questionnaire to distinguish genuine flu from other illnesses. Nice estimated that its limited go-ahead would result in 97,000 to 487,000 people being prescribed the drug on the NHS each winter, costing between £2.3m and £11.7m for England and Wales.

There was confusion over the meaning of the restriction on prescribing until the number of flu cases reaches 50 per 100,000 population. The institute said the figure referred to the level of flu in the local community but the Department of Health said national figures would be used.

Flu tends to strike in the north of the country first, so if national figures are used some patients in the North could be denied the drug until the 50 cases per 100,000 level for the whole country has been triggered. However, a spokeswoman for Nice said GPs would be allowed some discretion.

* A woman aged 66 has died of a rare complication of immunisation after a flu jab. Rita Gilhooly, of Milton in Glasgow, was taken ill two days after receiving the injection and was diagnosed with Guillain Barre syndrome, a disorder of the immune system that attacks the nerves, causing muscle weakness and paralysis. In 1 per cent of sufferers, the disorder is triggered by immunisation.

21 Nov 00 - Medicine - Relenza available on NHS

Patrick Butler

Guardian ... Tuesday 21 November 2000

The controversial anti-flu drug Relenza will be made available on the NHS on a strictly limited basis this winter after a health service advisory body overturned its own ban on the drug, issued last Autumn.

But the decision is bound by tight prescribing guidelines - the drug will only be made available to groups at risk of severe complications from flu such as the elderly, and only during officially classified general flu outbreaks.

The decision means Relenza may be prescribed to as little as 97,000 people, at a cost to the NHS of just £2.3m according to estimates by the National Institute for Clinical Excellence (Nice), which today issued its guidance on the use of the drug.

Nice predicts that if its guidance is effective, the numbers of patients eligible to receive Relenza would be limited to between three and 17 for each of the 29,000 GPs in England and Wales during the "flu season."

Trials suggest Relenza reduces the duration of flu symptoms from six to five days, and can allow infected adults to "return to normal activities" about half a day earlier than would otherwise be the case.

But the institute makes it clear that Relenza should not be used to treat flu in otherwise healthy people. "These patients are advised not to visit the GP but ...advised to stay at home and take medicines from the chemist to relieve the symptoms."

Separate guidance to GPs issued today by the Department of Health makes it clear that the government's flu immunisation programme, which it hopes will reach at least 60% of the 65 and over age group, will the "first line of defence" against the illness.

Relenza will be prescribed only to those patients who present themselves to GPs within 36 hours of the onset of "flu-like" illness when flu is "circulating generally in the community", and who are able to begin their course of treatment within 48 hours of the onset of symptoms.

A course of the drug, which is taken through an inhaler-like device twice daily, lasts five days and costs £24. It works by stopping the influenza virus from spreading between cells in the lungs.

Official guidelines state that flu is "circulating in the community" when there are between 50 and 400 cases per 100,000 GP consultations a week. Normally less than 50 out of every 100,000 visit their GP with flu-like symptoms every week.

An epidemic is defined as more than 400 cases per 100,000 GP consultations. The last official epidemic in the UK was in 1989-90 when 29,000 people died from flu.

Last October Nice advised that Relenza should not be available on the NHS because there was insufficient evidence that it would have a positive impact on the ability of the NHS to tackle flu.

Its manufacturer, GlaxoWellcome, said today it welcomed Nice's latest recommendation as an admission that Relenza had "a role to play in the treatment of influenza when the virus is circulating in the community for the treatment of at risk adults".

But Nice's decision represents only a partial vindication for the drug giant, which reacted furiously to last year's ban, at one point threatening to move its £1bn research and development operation from the UK to the United States.

21 Nov 00 - Medicine - Anti-flu drug for vulnerable groups

Staff Reporter

Independent ... Tuesday 21 November 2000

The National Institute for Clinical Excellence is reportedly about to approve Relenza for National Health Service use, just one year after the body recommended that the drug should not be made available because of its cost and doubts over its benefits.

Today, Nice is expected to issue guidance that Relenza should be made available for vulnerable groups like the elderly, diabetics and heart patients.

It is estimated that the £24-a-course drug could cost the NHS up to £15 million a year if there is a flu epidemic.

The chairman of the British Medical Association's GPs' Committee, Dr John Chisholm, said on BBC Radio 4's Today programme: "We are very fearful that, even with the drug just being available to high-risk individuals, that will place enormous additional demands on general practices and primary care during any epidemic."

The worst-case scenario was 75 additional consultations per general practitioner per week during an epidemic, he said. For general practice to have any hope of coping, it was essential that every local healthcare organisation put in place arrangements that would allow the dispensing of Relenza without a face-to-face consultation with a GP. High-risk patients with symptoms of a flu-like illness could then get the drug directly from a pharmacist or a nurse."

The decision by Nice was being watched closely by the City. Relenza's manufacturer, GlaxoWellcome, is set to merge with SmithKline Beecham.

There is some copncern, however, that the US Food and Drug Administration received reports that Relenza caused breathing problems in some patients.

21 Nov 00 - Medicine - Flu drug made available on NHS

Staff Reporter

Times ... Tuesday 21 November 2000

A limited number of at-risk patients should be given the flu drug Relenza through the National Health Service, experts ruled today.

The over-65s and people with chronic respiratory diseases, a lowered resistance to infection or diabetes should have access to the drug, the National Institute for Clinical Excellence (Nice) said.

The decision by Nice, which assesses the benefits of drugs to NHS patients, reverses a controversial ruling last year that no one should get Relenza - clinical name "zanamivir" - on a health service prescription.

Nice estimates that today's guidance to health authorities in England and Wales could mean up to nearly 500,000 people being prescribed Relenza at a cost of £11.7 million.

Andrew Dillon, the chief executive of Nice, said: "New evidence submitted by GlaxoWellcome (Relenza's makers) for this appraisal demonstrates benefits in using this product for people at risk of serious complications of flu."

Although it is not a cure, Relenza can reduce the duration of flu by up to two days as well as easing aches and pains associated with the virus. It has to be taken within hours of a patient developing symptoms, raising concerns about how patients will get the drug from their doctor.

People in the at-risk groups may be able to get Relenza after a telephone consultation with a nurse or doctor. NHS walk-in-centres may also be able to dispense the inhaler.

21 Nov 00 - Medicine - Push for anti-smoking drugs on NHS

Staff Reporter

Times ... Tuesday 21 November 2000

The smoking cessation drug Zyban and nicotine replacement therapy should be available on the NHS, new guidelines said today.

A review of the latest scientific evidence has led researchers to say that all restrictions on access to effective treatments should be scrapped.

Only limited numbers of patients in designated areas can get nicotine replacement therapy (NRT) on NHS prescriptions.

The National Institute for Clinical Excellence (Nice), the government body charged with assessing which medicines and treatments should be available on the NHS, is set to rule on the availability of Zyban and NRT next year.

But in a study published in the medical journal Thorax, researchers from St George's medical school in London said that the drug and NRT should be made available to all smokers wanting to stop.

20 Nov 00 - Medicine - Children prescribed 'untested' antibiotics

By Mark Henderson, Science Correspondent

Times ... Monday 20 November 2000

Family doctors are routinely prescribing drugs to children outside the terms of their safety licences , according to a study published yesterday.

Significant numbers of drugs are now prescribed to children on an "off-label" basis - using the doctor's discretion to stray from the strict criteria of the drug's licence - the research in Archives of Disease in Childhood found.

The problem is not normally the fault of doctors, the study, led by John McIntyre of the University of Nottingham, concluded. Rather the information supplied about the licensing arrangements for drugs is often unclear, and the licensing procedure does not keep pace with medical practice.

When a new drug appears on the market, its manufacturer must supply information about the patients for whom it has been safety-tested, and about recommended doses. Many drugs, including some common antibiotics, have not been explicitly tested on children because of the ethical difficulties in finding volunteers for trials. Other labels do not stipulate a reduced dose for young children, leading doctors to cut the dose themselves on an off-label basis.

The Nottingham team studied the prescribing records for 1997 for one suburban GP practice in the Midlands. They found that 3,347 prescriptions were given to 1,175 children involving 160 different drugs.

Although 84 per cent of prescriptions came within the terms of the product licence, one in ten was off-label , though just 0.3 per cent were for unlicensed drugs. Most off-label prescriptions, 89 per cent , related to dosage levels and involved antibiotics, asthma drugs and antihistamines.

The study concluded: "Children deserve the safety, efficacy and quality of medicines that the regulatory process affords to adults, and such anomalies and inadequacies need to be addressed."

A spokesman for the Association of the British Pharmaceutical Industry said: "We share the concerns raised and we are working to address them. But there are obvious ethical difficulties in conducting clinical trials on children."

19 Nov 00 - Medicine - Superbug is 'rife' in crisis hospital

By Jenny Booth and Lorraine Fraser

Telegraph ... Sunday 19 November 2000

The hospital where surgeons demanded a halt to operations because of filthy surgical implements has admitted that it has soaring numbers of patients infected with the antibiotic-resistant superbug MRSA.

Portsmouth Hospitals NHS Trust disclosed that the number of patients infected with MRSA at Queen Alexandra hospital and its sister hospital, St Mary's, was doubling each year . In 1999-2000, 480 patients contracted MRSA, and at least one died.

MRSA is a mutant strain of staphylococcus aureus, a common bacterium found mainly in hospitals, which has become resistant to most antibiotics through repeated exposure. It can be transmitted harmlessly on the skin, but when it infects a surgical wound it poses a serious danger to vulnerable patients.

The superbug problems are so serious that the nearby Chalybeate private BUPA hospital in Southampton refuses to admit patients from Queen Alexandra and St Mary's unless they provide two skin swab tests three days apart to prove that they are clear of MRSA.

Gisela Stuart, the health minister, last night gave the hospital one week to sort out its sterilisation problems or external managers would be drafted in. Ms Stuart acted after Queen Alexandra hospital admitted that it had halted hip and knee surgery three months ago because of problems at its sterilisation unit.

A Department of Health spokesman said: "The minister was informed there had been a problem but was told it had been resolved. It was not. The situation is totally unacceptable."

The unit could not sterilise enough instruments to meet the needs of surgeons, and The Telegraph has been told that in some cases supposedly sterilised instruments were sent back to operating theatres broken, rusty and with lumps of matter still clinging to them .

Hospital doctors said that hundreds of cataract operations have also been cancelled because a high number of patients developed signs of infection after surgery. The eye department has now restricted operations using a limited collection of instruments sent to nearby Royal Hospital Haslar to be sterilised.

Ten surgeons have written to the hospital's chief executive saying that emergency bone surgery must be halted within a fortnight because of the problems of sterilisation. The surgeons wrote: "We now feel that patients' lives and well-being are at serious risk."

In 1998-99, 240 patients caught the superbug in the two Portsmouth hospitals. That figure doubled the following year, and included Avis Carling who contracted it in the Queen Alexandra and died at 22. Between April and August this year it is understood that there were 425 new cases.

Jan Elliott, the deputy chief executive of the Portsmouth NHS Hospitals Trust, denied that there was a connection between the sterilisation problems and the high MRSA rates. She said that patients were catching MRSA in the community. "The risk is if you have an ill or vulnerable patient the infection can be transferred. But it is out there in the community and doesn't have a direct link with the hospital sterilisation and disinfection unit." She also denied that any patient had developed post-operative infections as a result of dirty surgical instruments .

More than 600 patients and staff at Bromley and Orpington hospitals in Kent have been tested for scabies after three patients, a physiotherapist and a nurse developed symptoms. Protective gloves and aprons have been issued to staff and visitors.

19 Nov 00 - Medicine - New varicose vein surgery speeds recovery

Mark Whiteley, a consultant surgeon who has carried out a series of operations using the new method, described it last night as "fantastic. The results just get better and better" . While varicose veins are frequently dismissed as a cosmetic problem, they are a sign of a serious problem with circulation in the leg.

Removing the damaged veins can improve blood flow and prevent future problems, but recovery after conventional surgery can take time. Traditionally, the operation involves the surgeon making an incision in the groin to "tie off" the saphenous vein, which runs the length of the leg. This is then pulled out, causing considerable trauma to local tissue. Millions of British adults suffer from varicose veins, and it is not just confined to women - one in seven adults has them, and many more have problems with blood flow in the leg without being aware of it. The National Health Service performs 100,000 varicose vein operations a year.

The treatment is one of the commonest reasons for seeking private medical care. Mr Whiteley, a vascular surgeon at the Royal Surrey County Hospital in Guildford and the private Guildford Nuffield Hospital, said: "[It] causes a lot of pain and bruising and most people are hobbling around afterwards for two to four weeks. The whole idea of this new technique is to destroy the vein where it is. Almost all the patients we do on a Friday afternoon or Saturday morning are out shopping that weekend and in over 100 cases, all bar one have been back at work on the Monday. We had one women who had both legs done on the Friday afternoon who was playing squash the following Thursday."

The procedure, called VNUS closure , requires only a needle-prick hole at the ankle. Using an ultrasound scanner to track its progress, a catheter is passed up the leg along the length of the vein to be removed. The leg is then bandaged to compress the vein and remove any blood, and an electric current is passed through the tip of the catheter. Although the catheter does not get hot, tissue in contact with it is heated to 85°C - the temperature at which collagen, which forms the framework of blood vessels, shrinks and breaks down. As the catheter is slowly removed the entire vein collapses. The technique was developed by VNUS Medical Technologies in Silicon Valley, California.

Most patients still need a general anaesthetic and a night in hospital. Some may have tiny cuts where surface veins are removed, but the risk of post-operative infection is reduced because there is no wound. Mr Whiteley said the procedure had been 100 per cent successful in 130 patients so far treated. Between three and 26 per cent of patients who had traditional surgery suffered a recurrence.

He said: "We have had 18 months of follow-up with this technique and we have not had any body who has had a vein re-open." After a year it was impossible to see the remains of the vein on ultrasound. The method was "without doubt" the better operation for people who had had recurrent varicose veins . The only side effect was an occasional dulling of feeling on the skin of leg if the vein had run close to the surface and the skin had also been heated, but it was hoped that even this could be avoided with improvements.

"Most of my patients are back to work by day two or three and back to the gym or full sport within three to five days," Mr Whiteley said. The one drawback is cost. The disposable catheters cost £600, which raises the price of varicose vein surgery in a private hospital from about £1,300 for a leg to almost £2,000. It is unlikely to be offered on the NHS although some insurers, particularly those managing company schemes, are willing to pay because of the benefit to the employer of getting the patient back to work.

Hilary Hetzel, 37, a Guildford theatre nurse who has had the new operation, said: "It's fantastic. I had the procedure done on my left leg on Saturday and by Sunday I was driving. I took my sons to the cinema on Monday morning with nothing more than a mild ache on certain movements in my leg and I was back at work on my next working day, Wednesday."

19 Nov 00 - Medicine - Germ-free childhood increases cancer risk

Roger Dobson

Sunday Times ... Sunday 19 November 2000

A germ-free childhood in a small family could expose young people to a higher than average risk of cancer, according to new research.

The doctors who carried out the study argue that if a child's immune system does not have to ward off illness and germs from other family members in the early years, it does not develop the strength necessary to fight more serious illnesses later in life.

In the study doctors found a link between lack of early exposure to infections and viruses, and the risk of developing non-Hodgkin's lymphoma (NHL) , a cancer of the lymphatic system.

The research, by a team from cancer institutes and universities in Italy, investigated the incidence of NHL and childhood infections. NHL is a highly malignant cancer, incidence of which is increasing at about 5% annually in Britain. Each year, 8,000 people are affected and about 4,500 die.

Doctors examined 4,000 people, half of them healthy, the other half with lymphoma. They found that people with NHL had developed infections later in childhood and adolescence than those who did not have the disease.

In Britain, one in 10 adults and one in seven children suffer from asthma , and it is now the most common chronic childhood disease in many developed countries.

By contrast, it is almost unheard of in most parts of Africa, where there is more exposure to germs in childhood and families are bigger.

Research carried out in London found that young children in a family are less likely to have allergy problems than older siblings.

It is thought that younger boys and girls who are exposed to bugs brought home by their older brothers and sisters are able to develop an immune system that is less sensitive to allergens. A decline in larger families may explain some of the increase in cases of asthma.

19 Nov 00 - Medicine - Pill may stop memory loss for elderly

Roger Dobson

Sunday Times ... Sunday 19 November 2000

A team of scientists believes it has discovered a way of reversing memory loss . The researchers say that, in as little as 10 years, a "memory pill " could be available to combat the absentmindedness of old age.

"Things are easily forgotten and the information doesn't soak in as well as it did when they were younger," said Dr Karl Peter Giese, head researcher in learning and memory at the Wolfson Institute, part of University College London, who led the team. "The drug would restore learning ability."

Mental activity depends on electrical signals between neurones, nerve cells in the brain. In old age the channels in the surface of the neurones, through which the current flows, become "furred up", and the neurones take longer to send the next electrical charge.

The team manipulated the genes of laboratory mice to prevent production of the proteins that blocks up the channels. They subsequently found that mice with modified genes were better at learning and remembering the path through a maze.

"Our theory was that changes in electrical activity in the neurons lead to the learning and memory deficit, and we have been able to show just that," said Giese, who worked with scientists in America, Germany and Norway. "We found that we could make the older mice learn as well as the younger age group could."

The researchers say that the same approach will work in humans, and plan to produce a pill to rejuvenate neurones for people over 60 . It could be used on a weekly or daily basis, depending on the patient's metabolism.

Any pills that helped to improve memory would be popular with pensioners. By 2030, when the post-war baby-boomers will be drawing their pensions, almost a quarter of the population will be over the age of 65.

In separate trials earlier this year, scientists at the Cold Spring Harbor Laboratory on Long Island, New York, identified a memory protein, a form of Creb (or cyclic AMP response element binding protein), which was found to help nerve cells in the brain to store memories. A sudden increase in the activity levels of the protein sent the memory-making process into overdrive, enabling neurons to make long-lasting storage structures immediately, without the slow work of repetition.

Scientists have already developed pills which they claim can slow the different form of mental degeneration caused by Alzheimer's disease. One of these, gelantamine, was developed from a chemical found in daffodil bulbs.

Opinion is divided on these medicines' effectiveness and they are almost unavailable in Britain.

Giese's proposed drug faces potential drawbacks, however. Any users would have to remember not to allow their less-aged relatives to use it because the researchers found that, in younger animals, it impairs learning ability.